All of the following are contraindications for breast conserving surgery except –
Correct Answer: Prior neoadjuvant chemotherapy
Description: Ans. is 'd' i.e., Prior neoadjuvant chemotherapy Breast conservative surgery (BCT)o Nvolves resection of the primary breast cancer with a margin of normal-appearing breast tissue, adjuvant radiation therapy with or without assessment of axillary lymph node statuso Various surgical procedures employed for BCT are - wide local excision, Lumpectomy & quadrantectomyo BCT is currently the standard treatment for women with DCIS, stage 1 & stage II invasive breast cancerso Suitable candidates for Breast Conservative Surgery are:1. The cancer is solitary, with no clinical or mammographic evidence of cancer elsewhere in the breast2. The tumor can be excised with tumor-free surgical margins without producing a cosmetically unacceptable breast.3. There are no contraindications to radiations4. The patient is willing and motivated for breast conservation.Contraindications for BCT1. There is more than one macroscopic carcinoma involving different quadrants of breast2. Diffuse, suspicious microcalcifications on mammography.3. Multicentricity4. Persistant positive margins, after reasonable surgical attemptso The most important reason for recurrence is inadequate clearance of tumor5. Large tumors > 4 cmo Large size is only a relative contraindicationo Tumor of any size can be removed permitted that it leaves behind a cosmetically acceptable breast6. Centrally located tumor for which removal of the nipple is required to obtain a tumor-free margin.o This is also a relative contraindication, depends on patients acceptibility. The nipple and areola can now be reconstructed.7. The patient has no access to radiation facility or is unlikely to complete a course of radiation or is not able to undergo radiation8. Contraindications to radiationo Prior therapeutic radiation to breast regiono Presence of collagen vascular disease (Scleroderma, SLE or rheumatoid arthritis) which may show an exaggerated reaction on irradiationo First or second trimester of pregnancy9. Fixity of tumor to chest wall or overlying skin10. Large pendulous breasto A relative contraindication, as it presents difficulty in delivering a uniform radiation dose.11. Low socio-economic statuso As they are difficult to follow-upo Regular follow-up with mammography and clinical examination is necessary to detect any recurrence, early on.Not a contraindication1. Bilateral breast tumors2. Axillary lymph node metastasis3. Presence of breast implants4. Elderly patients5. Positive family history
Category:
Surgery
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